Tongue implant

ABSTRACT

A patient&#39;s obstructive sleep apnea is treated by identifying a patient with sleep apnea attributable at least in part to movement of a base of a tongue of the patient toward a pharyngeal wall of the patient. The tongue is stiffened by an implant sized to be placed within the tongue. A distal portion of the implant is sized to extend within the tongue from a first end near a mandibular-geniohyoid interface to a second end near a base of the tongue. A proximal portion is attached to the first end and adapted to be secured to a jaw bone of the patient following a period of healing after placement of the implant in the tongue.

CROSS-REFERENCE TO RELATED APPLICATION

The present application is a continuation of U.S. patent applicationSer. No. 11/706,729, filed Feb. 15, 2007; which is acontinuation-in-part of U.S. patent application Ser. No. 11/542,455,filed Oct. 3, 2006; which applications are hereby incorporated byreference in their entirety.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention pertains to a method for treating a condition of an upperairway of a patient. More particularly, this invention is directed to amethod for treating obstructive sleep apnea by stiffening a tongue of apatient.

2. Description of the Prior Art

Upper airway conditions such as obstructive sleep apnea (“OSA”) andsnoring have received a great deal of attention. These conditions haverecognized sociological and health implications for both the patient andthe patient's bed partner.

Numerous attempts have been made towards treating OSA and snoring. Theseinclude placing implants in either the tissue of the soft palate or thepharyngeal airway as disclosed in commonly assigned U.S. Pat. No.6,250,307 to Conrad et al. dated Jun. 26, 2003, U.S. Pat. No. 6,523,542to Metzger et al. dated Feb. 25, 2003 and U.S. Pat. No. 6,431,174 toKnudson et al. dated Aug. 13, 2002. Further, U.S. Pat. No. 6,601,584 toKnudson et al. dated Aug. 5, 2003 teaches a contracting implant forplacement in the soft palate of the patient.

Another prior art technique for treating OSA or snoring is disclosed inU.S. Pat. No. 5,988,171 to Sohn et al. dated Nov. 23, 1999. In the '171patent, a cord (e.g., a suture material) (element 32 in FIG. 6 of the'171 patent) is placed surrounding a base of the tongue and secured tothe jaw by reason at an attachment member (element 20 in FIG. 6 of the'171 patent). In the method of the '171 patent, the member 32 can beshortened to draw the base of the tongue toward the jaw and thereby movethe tissue of the base of the tongue away from the opposing tissue ofthe pharyngeal airway. However, this procedure is often uncomfortable.This procedure, referred to as tongue suspension, is also described inMiller et al., “Role of the tongue base suspension suture with TheRepose System bone screw in the multilevel surgical management ofobstructive sleep apnea”, Otolaryngol. Head Neck Surg., Vol. 126, pp.392-398 (2002).

Another technique includes debulking tissue by applying radio frequencyablation to either the tongue base or of the soft palate to debulk thetissue of the tongue or palate, respectively. This technique isillustrated in U.S. Pat. No. 5,843,021 to Edwards et al. dated Dec. 1,1998. RF tongue base reduction procedures are described in Powell etal., “Radiofrequency tongue base reduction in sleep-disorderedbreathing: A pilot study”, Otolaryngol. Head Neck Surg., Vol. 120, pp.656-664 (1999) and Powell et al., “Radiofrequency Volumetric Reductionof the Tongue—A Porcine Pilot Study for the Treatment of ObstructiveSleep Apnea Syndrome”, Chest, Vol. 111, pp. 1348-1355 (1997).

A surgical hyoid expansion to treat OSA is disclosed in U.S. Pat. No.6,161,541 to Woodson dated Dec. 19, 2000. Other tongue treatments forOSA include stimulation of the hypoglossal nerve. This procedure isdescribed in Eisle et al., “Direct Hypoglossal Nerve Stimulation inObstructive Sleep Apnea”, Arch. Otolaryngol. Head Neck Surg., Vol. 123,pp. 57-61 (1997).

Commonly assigned U.S. patent applications Publication Nos. US2005/0092332 A1 and US 2005/0092334 A1 (both published May 5, 2005)describe tongue-based treatments to treat obstructive sleep apnea. U.S.patent applications Ser. Nos. 11/107,160 and 11/107,161 (both filed Apr.15, 2005 and assigned to the assignee of the present invention) describevarious implants for a tongue to treat obstructive sleep apnea.

European Patent EP 1,039,859 B1 granted Dec. 3, 2003 describes a braceplaced in the tongue. German Patent No. 19 920 114 describes struts inpharyngeal wall. U.S. patent applications Publication Nos. US2005/0126563 A1 published Jun. 16, 2005 and US 2005/0199248 A1 publishedSep. 15, 2005 describe stents in an airway. U.S. patent applicationsPublication Nos. US 2004/0139975 published Jul. 22, 2004 and US2004/0149290 published Aug. 5, 2005 (both assigned to Apneon Inc.)describe struts or magnets in the tongue.

SUMMARY OF THE INVENTION

According to a preferred embodiment, obstructive sleep apnea of apatient is treated by identifying a patient with sleep apneaattributable at least in part to movement of a base of a tongue of saidpatient toward a pharyngeal wall of said patient. The method includesidentifying a region in the tongue extending from amandibular-geniohyoid interface to the base of the tongue and stiffeninga tissue of the tongue throughout the identified region. The region isstiffened by an implant sized to be placed within a tongue of thepatient. A distal portion of the implant is sized to extend within thetongue from a first end near a mandibular-geniohyoid interface to asecond end near a base of the tongue. The proximal portion is attachedto the first end and adapted to be secured to a jaw bone of the patientfollowing a period of healing after placement of the implant in thetongue. In a most preferred embodiment, at least a portion of theproximal portion is formed of an elastomeric material for the implant tostretch and contract in response to movement of the tongue during speechand swallowing.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side sectional schematic view of an upper airway of apatient and illustrating various anatomical features;

FIG. 2 is the view of FIG. 1 showing an implant of the present inventionplaced within the tongue according to a treatment method of the presentinvention;

FIG. 3 is a side elevation view of the implant of FIG. 1;

FIG. 4 is a perspective view of the implant of FIG. 3;

FIG. 5 is the view of FIG. 1 showing an incision formation tool placedwithin the tongue;

FIG. 6 is the view of FIG. 5 with the incision formation tool actuatedto an open position to form a pocket for receiving the implant of FIG.3;

FIG. 6A is a view taken along line 6A-6A in FIG. 6;

FIG. 7 is the implant of FIG. 3 disposed on an implant insertion toolbefore final deployment;

FIG. 8 is a view taken along line 8-8 of FIG. 7;

FIG. 9 is the view of FIG. 7 with the implant insertion tool moved to anopen position to fully place the implant within a pocket formed withinthe tongue;

FIG. 10 is the view taken alone line 10-10 of FIG. 9;

FIG. 11 is the top plan view of a tongue showing positioning of twoimplants within the tongue;

FIG. 12 is a view taken along line 12-12 of FIG. 11;

FIG. 13 is a top plan view of a tongue showing an entire target regionbeing stiffened;

FIG. 14 is the view of FIG. 1 showing the entire target region of FIG.13;

FIG. 15 is the view of FIG. 2 showing an alternative embodiment of animplant according to the present invention showing multiple implants inthe tongue;

FIG. 16 is a perspective view of a tubular implant used in theembodiment of FIG. 15;

FIG. 16A is an end elevation view of the implant of FIG. 16;

FIG. 17 is a top plant view of a tongue with implants of FIG. 16arranged extending along an anterior-posterior axis of the tongue;

FIG. 18 is the view of FIG. 17 with the implants disposed in the targetregion of FIG. 13;

FIG. 19 is a side elevation view of a further alternative embodiment ofan implant according to the present invention;

FIG. 20 is the view of FIG. 19 showing the tool of FIG. 5 in a closedposition inserted within the implant of FIG. 19;

FIG. 21 is the view of FIG. 20 with the tool shown in an open position;

FIG. 22 is a side elevation schematic view of a portion of an upperairway of a patient showing the implant of FIG. 21 deployed within atongue of a patient before attachment of the implant to a jaw bone ofthe patient; and

FIG. 23 is the view of FIG. 22 following attachment of the implant tothe jaw bone.

DESCRIPTION OF THE PREFERRED EMBODIMENT

With reference now to the various drawing figures in which identicalelements are numbered identically throughout, a description of thepreferred embodiment of the present invention will now be provided.

1. Disclosure of Parent Application

FIG. 1 is a schematic representation of an upper airway of a patient.FIG. 1 shows the tongue T with a tongue base TB opposing a pharyngealwall PW. The hard palate HP and soft palate SP reside over the top oftongue T with the soft palate SP extending rearward to a trailing end TEbetween the tongue base TB and the pharyngeal wall PW.

A hyoid bone HB resides near the bottom of the tongue near an epiglottisE. A mandible or jaw bone JB is at the front of the tongue T. Thegeniohyoid muscle GH extends between the jaw bone JB and the hyoid boneHB at the bottom of the tongue T. The lines A of FIG. 1 illustrate thedirection of muscle fibers in the geniohyoid muscle GH. The genioglossusmuscle GG resides above the geniohyoid muscle GH. The genioglossusmuscle GG has muscle fibers B which extend from the jaw bone JB andcurve to radiate toward the surface of the tongue T.

When reclining during sleep, the tongue base TB may, in response togravity or airflow, drop down in closer approximation to the pharyngealwall PW. During sleep, the muscles of the tongue T (principally thegenioglossus muscle GG) can stretch permitting the tongue T to fall backtoward the pharyngeal wall PW.

The present invention is directed towards method and apparatus forstiffening the muscles of the tongue T in a manner to preclude thetongue T from falling toward the pharyngeal wall PW while avoidinginterference with normal functions of the tongue T during speech andeating.

FIG. 2 illustrates the present invention as an implant 10 placed withinthe interior of the tongue T. The implant 10 has a proximal end 12 and adistal end 14. In a preferred embodiment, the implant 10 is asubstantially planar sheet formed as a generally conical envelope bestillustrated in FIG. 4. The distal end 14 is the base of a cone withopposing edges of the base being stitched or otherwise bonded togetherso that the interior of the implant 10 is accessible only through theproximal end 12. The implant 10 is a flat sheet with opposing surfacesof the cone compressed against one another.

The implant 10 is sized to be received within the tongue T with theproximal end 12 positioned in a region of the tongue T adjacent theinterface of the jaw JB and geniohyoid muscle GH. The height of theproximal end 12 (illustrated as H_(P) in FIG. 3) is sized for theproximal end 12 to be received within the tongue T at the juncture ofthe jaw bone JB and the geniohyoid muscle GH. The implant 10 is furthersized to have a length L for the distal end 14 to be positioned adjacentthe tongue base TB in close proximity to the tongue base TB when theproximal end 12 is positioned in a region of the tongue T adjacent theinterface of the jaw JB and geniohyoid muscle GH. The height of thedistal end 14 (illustrated as H_(D) in FIG. 3) is sized for the distalend 14 to extend within the tongue base TB substantially covering aregion of the tongue base TB opposing the pharyngeal wall PW between theepiglottis E and the trailing end TE of the soft palate TB. By way ofnon-limiting example, representative dimensions for H_(P), H_(D) and Lare 1.0 centimeter, 2.5 centimeters and 4 centimeters, respectively. Thefibrils of the material of implant 10 are about 20 microns to 100microns in diameter. Depending on the braid or weave and the fibrildiameter, the thickness of a sheet of the material may range from 50 to500 microns. A double thickness TH (FIG. 12) (which is transverse to theanterior-posterior axis of the tongue T following implantation) would beabout 100 to 1000 microns.

The material of the implant 10 is selected to produce a fibroticresponse from the tissue of the tongue T following implantation of theimplant 10 within the tongue T. The specific materials and constructionmay be varied to alter the degree of fibrotic response resulting fromsuch implantation. By way of non-limiting example, the material of theimplant 10 may be a knit or woven polyester or polypropylene materialknown to result in a fibrosis formation following implantation.

FIGS. 5-10 illustrate a technique and tools for placement of the implant10 within the tongue. In FIG. 5, a tool 20 is shown for forming anincision in the tongue T sized to receive the implant 10. The tool 20includes a curved handle 22 and a scissors end 24. The scissors end 24is hinged to the handle at hinge point 26 and includes a pair of scissorblades 28, 30 (shown in FIG. 6). The tips 29, 31 of the blades 30, 28are sharp to permit insertion of the tips 29, 31 through tissue into thetongue T. Further, the edges 27, 33 of the blades 28, 30 are sharp topermit slicing action of the scissor blades 28, 30 through tissue.

In use, the blades 28, 30 are collapsed so that they are in parallelalignment as shown in FIG. 5. The tips 31, 29 are passed through thepatient's open mouth and are inserted into the tongue T at the frontlower extremity of the tongue T just behind the jaw bone JB. Insertionis first made by urging the tips 29, 31 downwardly into the region ofinterface between the geniohyoid muscle GH and the jaw bone JB and thencurving the direction of travel upwardly to urge the tips 29, 31 towardthe tongue base TB.

When the tool 20 is in the position of FIG. 5, the scissor blades 28, 30are opened as shown in FIG. 6 to cut a pocket for receiving an implant10. The tool 20 is then removed. The arcuate nature of the handle 22permits formation of an incision pocket extending from the geniohyoidmuscle GH at the jaw JB toward the tongue base TB between the epiglottisE and the trailing end TE of the soft palate SP.

Following formation of the pocket, an insertion tool 40 is provided asillustrated in FIG. 7. Insertion tool 40 is similar in construction tothe incision formation tool 20. It includes a curved handle 42 andscissor action blades 44, 46. Unlike blades 28, 30, the blades 44, 46 donot have knife edges in order to avoid damage to the implant 10.

With the blades 44, 46 in parallel alignment as shown in FIGS. 7 and 8,the tips of the blades 44, 46 are inserted into the interior of theimplant 10 through the proximal end 12. The implant 10 can then befolded surrounding the blades 44, 46 into a compact configurationsurrounding the blades 44, 46 as shown in FIGS. 7 and 8. The tool 40carrying the implant 10 is placed into the incision pocket formed bytool 20. Such positioning is shown in FIG. 7. After such positioning,the blades 44, 46 are actuated to an open position shown in FIG. 9urging the implant 10 to its expanded state. The blades 44, 46 can thenbe returned to their collapsed state and removed from the tongue Tleaving the implant 10 in desired position within the tongue T.Referring to FIG. 10, in the expanded state, the implant has asubstantially planar sheet construction as defined by the width of theopened blades 44, 46 of the insertion tool 40. In contrast and as willbe described in greater detail hereinafter, other implant embodimentsmay have a tubular construction.

As mentioned, it is desired that the proximal end 12 of the implant 10be as positioned as close as possible to the jaw bone JB in the regionof the geniohyoid muscle GH. If necessary, the surgeon can formadditional incisions through the tongue T to pull the proximal end 12into the geniohyoid muscle GH in close proximity to the jaw bone JB.

FIG. 11 shows two implants 10, 10′ positioned within the tongue T in themanner such as that previously described. Ideally, the implants 10, 10′extend along the anterior posterior A-P axis. The proximal ends 12, 12′are positioned in close approximation to the anterior-posterior axisA-P. Preferably, the implants 10, 10′ do not extend straight back.Instead, they are angled outwardly toward the sides of the tongue T. Asa result, the distal ends 14, 14′ are spaced apart at opposite lateralextremities of the tongue base TB.

Following implantation, a fibrotic capsule FC forms around the materialof the implant 10. The capsule FC is illustrated in FIG. 12. Thefibrotic capsule FC adds stiffness to the tissue of the tongue T.

At the juncture of the geniohyoid muscle GH and the jaw bone JB(referred to herein as the “mandibular-geniohyoid interface”, musclefibers of the tongue are tendon-like. By “tendon-like”, it is meant themuscle fibers are less susceptible to stretching than the remainder ofthe length of the fibers. Since the fibrotic capsule FC and the proximalend 12 of the implant 10 originate in this region, a substantiallynon-stretchable region is formed in the tongue T by reason of thefibrotic capsule FC and the implant 10.

In the absence of an implant 10, substantially the entire length ofmuscle fibers from the jaw bone JB to the tongue base TB can stretchduring sleep resulting in the tongue base TB falling against the softpalate SP or pharyngeal wall PW during sleep. With the implant 10extending from the jaw bone JB to the tongue base TB, the muscle fibersin contact with the implant 10 and resulting fibrotic capsule FC aremuch less susceptible to stretching.

Use of two implants 10, 10′ (FIG. 11) forms two such non-stretchableplanes within the tongue T. The placement of FIG. 11 ties the tonguebase TB to the jaw bone JB with the lateral extremities of the tonguebased TB being treated to resist stretching. If desired, a third implantcould be placed along the anterior-posterior axis A-P to further resisttongue stretching.

FIGS. 13 and 14 illustrate extreme treatments where the entire volume ofthe tongue from the mandibular-geniohyoid interface to the base of thetongue is stiffened. This volume V is illustrated in FIGS. 13 and 14 asa shaded area. The volume is defined as a generally conical volumehaving an apex at the mandibular-geniohyoid interface. The base of theconical volume is at the tongue base TB near the surface of the tongueand covering the portion of the tongue base TB opposing the pharyngealwall PW between the epiglottis E and the training end TE of the softpalate SP. The volume V extends between the lateral extremities of thetongue base TB.

Treatment of the entire volume can be accomplished by multiple implants10 placed as described above. Alternatively, the volume V can beinjected with any fibrosis-inducing agent (e.g., microbeads) throughoutthe volume V.

Ideally, the implant 10 will contract and expand with the muscle as itheals. Otherwise, a capsule surrounding the implant 10 will form asmuscle slides over the implant 10. This property is enabled by acombination of factors: the restoring force of the implant 10, thefriction against the tissue and attachments if any at either end. Themesh material of the implant 10 aids in achieving these objectives. Thegoal is to have an appropriate amount of spring tension/expansion andwall friction/in-growth such that the implant 10 contracts and expandswith tissue. It is desirable to avoid an implant so stiff as to overlycontract the muscle. This may cause the distal end of the implant toslide more proximal. As the scar forms and contracts, the implantcontracts more permanently with the scar. This suggests the restoringforce decreases over time. Biodegradable fibers suitable for thispurpose or biodegradable coatings on the fibers themselves (which adherethe fibers together) may be used. The elastic properties of the implantshould are approximately between 5 kPa to 50 kPa. The frictional forceshould be approximately 2N to 4 N. The patient's physiology and the sizeof the implant affect the range for these values.

FIGS. 15-18 illustrate an alternative embodiment in which the targetarea or volume of the tongue is stiffened by placement of a plurality oftubular implants 10″. One such implant 10″ is separately shown in FIGS.16 and 16A. In a representative embodiment, the implant 10″ is tube ofpolyester or other material selected to induce fibrosis followingimplantation in the tongue T. The implant 10″ has a length L′ of 3-5centimeters, an outside diameter D_(O) of about 1 mm to 3 mm and aninside diameter D₁ resulting from a wall thickness of about 50 to 500microns. Implants 10″ for a single patient need not all be the samelength L′. More interior implanted tubes 10″ may be shorter so thatproximal ends 12″ do not impinge upon one another when multiple implants10″ are used (as will be described).

The implant 10″ may be placed with a proximal end 12″ at themandibular-geniohyoid interface and with a distal end 14″ at the tonguebase TB. FIG. 15 shows three such implants 10″ disposed in a verticalplanar array 16″ substantially filling the plane of implant 10 of FIG.2. A single such array 16″ may be positioned in line with the anteriorposterior axis A-P (as shown in FIG. 17) or multiple such arrays 16″ maybe positioned similar to the positioning of implants 10 in FIG. 11 (asillustrated in FIG. 18). Use of tubular implant 10″ permits a moreuniform distribution of implants in the target volume V and creation ofa filled target volume of more conical shape.

The insertion tool for the tube shaped implants 10″ may be much like theinsertion tool described in U.S. patent application Publication No.2005/0154412 A1 (incorporated herein by reference) which describes atool for placing a solid braided implant such as that marketed byassignee of the present application (Restore Medical Inc., St. Paul,Minn., USA) under the trademark “Pillar”. The tool may be modified toreplace the needle of the tool with a rod received within the implant10″ through the proximal end 12″. The rod may extend to the distal tip14″ of the implant 10″. Retracting the rod leaves the implant 10″ indesired position in the tongue T.

In the foregoing example, no stiffening treatment is made in the tongueT in the upper region of the tongue T. Generally defined herein as theregion of the tongue T above and forward of a line from the jaw bone JBto the trailing end of the hard palate HP, this region of the tongue Tis active in speech and swallowing. Since no treatment is made in thisregion, these functions are not impaired.

2. Additional Disclosure of the Present Application

FIGS. 19-23 illustrate an alternative embodiment of the presentinvention. In FIGS. 19-23, an implant 100 includes a distal portion 110and a proximal portion 120. The distal portion 110 is preferably a meshconstruction such as a braid or knit which has interstitial spaces forpromoting fibrosis and tissue ingrowth. The distal portion 110 ispreferably constructed the same as implant 10 previously described. FIG.19 shows the implant 100 with distal portion 110 in a collapsed statewhile FIG. 21 shows the distal portion 110 in a fully expanded state.The distal portion 110 includes a side slit 115 for receiving the blades44, 46 of the previously described incision formation tool 40.

The proximal portion 120 is an elastomeric material such as silicone orthe like. The silicone is molded over a first end 111 of the distalportion 110 to define an over-molded portion 170 (FIG. 19).

The silicone proximal portion 120 includes a most proximal reinforcedregion 130. Region 130 may have reinforcing fibers such as polyester toreinforce the strength of the silicone in the region 130. The region 130includes a plurality of holes 140 spaced along the length of the region130 for receiving an attachment screw 150 (shown only in FIG. 23). Thesilicone proximal portion 120 includes unreinforced region 150 so thatthe region 150 may elastically stretch for purposes that will becomeapparent. By way of non-limiting example, region 130 is about 1.5 cm inlength, region 150 is about 2 cm and region 160 (the length of portion110 not contained within silicone) is about 3 cm. (See FIG. 20).

In use of the implant 100, the incision formation tool 40 forms anincision within the tongue T as previously described. With the blades44, 46 in the closed position, the blades are inserted through the slit115 into the interior of the distal portion 110 as illustrated in FIG.20. The combination is then inserted into the tongue T where the blades44, 46 are moved to the open position causing the distal portion 110 toexpand as illustrated in FIG. 21. FIG. 22 shows the expanded distalportion 110 within the tongue T following removal of the incisionformation tool 40.

After a period of time (for example, about 4 weeks), a healing processoccurs and fibrosis results attaching the tissue of the tongue T to themesh material of the distal portion 110. Following such healing, anincision (not shown) may be made into the tongue T from beneath the chinof the patient. The physician grabs the proximal portion 120 andretracts it relative to the base of the tongue TB. This causes aretraction of the tongue base TB from the pharyngeal wall. FIG. 23illustrates this in an exaggerated manner with the original tongue baseTB shown in phantom lines and the repositioned tongue base shown insolid lines TB.

With the tongue base TB so retracted, the proximal portion 120 isattached to the jaw bone JB by passing screw 150 through a select one ofthe holes 140 and into the jaw bone JB. The incision can then be closedwith the apparatus 100 remaining in the position shown in FIG. 23.

During normal tongue functions such as speech and swallowing, the tongueT may be urged to move away from the jaw bone JB. This movement isfacilitated by the elastic material of the proximal portion 120 so asnot to interfere with normal speech and swallowing functions of thetongue.

It has been shown how the present invention has been obtained in apreferred embodiment. Modifications and equivalents of the disclosedconcepts are intended to be included within the scope of the claimswhich are appended hereto.

1. A method for treating obstructive sleep apnea comprising: identifyinga patient with sleep apnea attributable at least in part to movement ofa base of a tongue of said patient toward a pharyngeal wall of saidpatient; identifying a region in the tongue extending from amandibular-geniohyoid interface to the base of the tongue; stiffening atissue of the tongue throughout the identified region; wherein saidstiffening includes placing an implant of fibrosis-inducing materialwithin the tongue with the implant extending within said region with thematerial selected to induce formation of fibrosis along said region; andattaching a proximal end of the implant to a jaw bone of the patient. 2.A method according to claim 1 wherein the identified region includes anarea of the base of the tongue opposing the pharyngeal wall between anepiglottis and a trailing end of a soft palate.
 3. A method according toclaim 1 wherein the identified region includes an area of the base ofthe tongue between lateral extremities of the base of the tongue.
 4. Amethod according to claim 1 wherein said implant is sized for saidregion to extend substantially between an epiglottis and a soft palateof the patient at the base of the tongue.
 5. A method according to claim4 wherein said implant is a substantially planar sheet when placed inthe tongue with a narrow dimension extending transverse to the tongue,the proximal end of the implant being located within said region at saidmandibular-geniohyoid interface, a distal end of the implant beinglocated within the tongue at the base and extending between theepiglottis and the soft palate.
 6. A method according to claim 1 whereinsaid implant is a tubular material selected to induce fibrosisformation, the proximal end of the implant being located at saidmandibular-geniohyoid interface, a distal end of the implant beinglocated at said base of the tongue.
 7. A method according to claim 6wherein said region includes an area of the base of the tongue betweenlateral extremities of the base of the tongue and said method includesplacing multiples of said implants in a volume of said tongue withinsaid region.
 8. A method according to claim 1 wherein a material of saidimplant is selected for said implant to contract and expand with thetongue as the tongue heals.
 9. A method according to claim 1 wherein theproximal end is attached to the jaw bone following a period of healingafter placement of the implant in the tongue.
 10. A method according toclaim 1 wherein the proximal end of the implant is attached to a distalend of the implant by an elastic connection.
 11. A method according toclaim 1 wherein a proximal portion of the implant is elastomeric.
 12. Amethod according to claim 11 wherein the elastomeric proximal portionexpands and contracts with movement of the tongue in response to speechand swallowing.
 13. A method according to claim 12 wherein theelastomeric proximal portion includes a reinforced region thatfacilitates attachment of the implant to the patient's jaw bone and anunreinforced region that permits the movement of the tongue.
 14. Anapparatus treating obstructive sleep apnea of a patient, said apparatuscomprising: an implant sized to be placed within a tongue of thepatient; the implant having a proximal portion and a distal portion; thedistal portion sized to be implanted in the tongue near a base of thetongue; the distal portion selected of a material for creating afibrotic response following implantation in the tongue; the proximalportion including a first end adapted to be secured to a jaw bone of thepatient, wherein at least a portion of the proximal portion iselastomeric, the elastomeric proximal portion being selected to expandand contract with movement of the tongue in response to speech andswallowing.
 15. An apparatus according to claim 14 wherein the distalportion is a material with interstitial spaces for tissue in-growth. 16.An apparatus according to claim 15 wherein the material is a mesh. 17.An apparatus according to claim 14 wherein the elastomeric proximalportion includes a reinforced region that facilitates attachment of theimplant to the patient's jaw bone and an unreinforced region thatpermits the movement of the tongue.